No Added Benefits of Cranial Bypass in Stroke Prevention

For patients with atherosclerotic internal carotid artery occlusion, surgery doesn't cut stroke risk

TUESDAY, Nov. 8 (HealthDay News) -- Extracranial-intracranial (EC-IC) bypass surgery in addition to medical therapy offers no additional benefit over medical therapy alone in preventing recurrent stroke in recent symptomatic atherosclerotic internal carotid artery occlusion (AICAO), according to a study published in the Nov. 9 issue of the Journal of the American Medical Association.

William J. Powers, M.D., from the University of North Carolina School of Medicine in Chapel Hill, and colleagues investigated whether addition of EC-IC bypass surgery to the best medical therapy would reduce ipsilateral ischemic stroke at two years. Patients with recent arteriographically-confirmed AICAO and hemodynamic cerebral ischemia identified by positron emission tomography measurements of oxygen extraction fraction were randomized to receive surgery (97 participants) and no surgery (98 participants). Surgery consisted of anastomosis of the superficial temporal artery branch to a middle cerebral artery cortical branch. The primary end point was all strokes and deaths from surgery through 30 days after surgery and from randomization to randomization plus 30 days for the surgical and non-surgical groups, respectively. Ipsilateral ischemic stroke within two years of randomization was measured for both groups.

The investigators terminated the trial prematurely due to futility. The two-year primary end point rates were 21 and 22.7 percent for the surgical and non-surgical groups, respectively (P = 0.78). A 12.4 percent difference was observed for the 30-day rates of ipsilateral ischemic stroke in the two groups (14.4 percent in the surgical group versus 2 percent in the nonsurgical group).

"EC-IC bypass surgery failed to provide an overall benefit on two-year stroke recurrence," the authors write.

One study author disclosed financial ties to the pharmaceutical and medical device industries. Another author disclosed financial ties to W. L. Gore and Associated, which manufactures aneurysm grafts and vascular stents.

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